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Purpose of Review <p>This review assesses high-resolution intravascular ultrasound (HR-IVUS) in characterizing coronary vulnerable plaques and enhancing acute coronary syndrome (ACS) management, focusing on its clinical applications and emerging technologies for risk stratification and personalized treatment.</p> Recent Findings <p>HR-IVUS, with 20–50 μm resolution, outperforms conventional IVUS (70–150 μm), identifying thin-cap fibroatheromas (TCFAs) and high-risk features like lipid content. Multimodal imaging (IVUS-NIRS, IVUS-OCT) improves accuracy, while ultrahigh-frequency ultrasound (&gt;100 MHz) achieves 14–24 μm resolution, though penetration is limited. Dual-element IVUS enhances stability, and AI boosts plaque classification (up to 92.6% accuracy). Studies (e.g., PROSPECT) link HR-IVUS features (plaque burden &gt;70%) to a fivefold higher MACE risk. Challenges include cost and validation.</p> Summary <p>HR-IVUS advances ACS risk assessment with superior plaque detection. Innovations in imaging and AI enhance its utility, promising broader applications despite current limitations, potentially reducing ACS incidence and supporting precision cardiovascular care.</p>

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High-Resolution Intravascular Ultrasound: Advances in Coronary Plaque Characterization

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月29日

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  • Baoqiang Liu,
  • Qifa Zhou

摘要

Purpose of Review

This review assesses high-resolution intravascular ultrasound (HR-IVUS) in characterizing coronary vulnerable plaques and enhancing acute coronary syndrome (ACS) management, focusing on its clinical applications and emerging technologies for risk stratification and personalized treatment.

Recent Findings

HR-IVUS, with 20–50 μm resolution, outperforms conventional IVUS (70–150 μm), identifying thin-cap fibroatheromas (TCFAs) and high-risk features like lipid content. Multimodal imaging (IVUS-NIRS, IVUS-OCT) improves accuracy, while ultrahigh-frequency ultrasound (>100 MHz) achieves 14–24 μm resolution, though penetration is limited. Dual-element IVUS enhances stability, and AI boosts plaque classification (up to 92.6% accuracy). Studies (e.g., PROSPECT) link HR-IVUS features (plaque burden >70%) to a fivefold higher MACE risk. Challenges include cost and validation.

Summary

HR-IVUS advances ACS risk assessment with superior plaque detection. Innovations in imaging and AI enhance its utility, promising broader applications despite current limitations, potentially reducing ACS incidence and supporting precision cardiovascular care.